Ganglion Cyst: Symptoms, Causes, Diagnosis and Treatment
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Ganglion Cyst: Symptoms, Causes, Diagnosis and Treatment

Ganglion Cyst: Symptoms, Causes, Diagnosis and Treatment

Reviewed by doctors of Asia Medical Specialists

Last update: November 1st 2021

 

Fig. 1  Ganglion Cyst 

What is Ganglion Cyst？

Ganglion cysts is the most common lump that found on the wrist and fingers.(Fig 1)  It is a synovial cyst filled with gelatinous mucoid material and forms a round or oval shape.  They most commonly develop along the tendon or joints of a person wrist or hands.  Although the cyst itself is benign, the annoying habit of coming back is disturbing.  Do note Ganglion cyst is not cancerous it is benign and won’t spread to other areas1. 

The Anatomy of Ganglion Cyst

The cysts usually show up on the back and palm side of the hand near the wrist. Sometimes, the cysts would pop up in other areas that joins and tendon are located such as:

  • The base join fo the fingers on the palm
  • Near finger tip
  • The outer side of knee and ankle
  • On top of the foot

What are the symptoms Ganglion Cyst？

  • Location:  The cyst usually develops along the tendons or joints of the patient wrist and hands.  Sometimes, it also would develop at the ankles and feet.
  • Shape and size: they are sually round  or oval in shape and most likely they are less than an inch in diameter.  The cyst would sometimes grow overtime as the patient continuously use the affected joint
  • Pain:  It is usually painless unless the cyst is putting pressure over a nerve.  When this occur, tiggling sensation, pain, numbness or even weakness over muscles occurs.

Other conditions similar to Ganglion cyst

Sometime Ganglion due to its nature of appearance are misdiagnose with other conditions such as:

  • Lipoma
  • Fibroma
  • Epidermoid inclusion cysts

Doctors would use a Transillumination test to distinguish ganglion cyst from other conditions. 

Ganglion cyst Diagnosis

If you ever developed a lump, it is always reccomended to see a doctor to rule out all possibilities, even if there is no symptoms that bothers you.  In most cases, a simple phyiscal examination is needed to dianose a ganglion cyst.

  • Examination of the fluid:  Sometimes doctors would like to get further confirmation by draining some of the fluid out of the cyst. ( Needle aspiration)
  • Ultrasound:  This is also another way to get further confirmation.  By using the ultrasound, the doctor can confirm whether the cyst is fluid-filled or it is solid.
  • Transillumination test:  The dcotor will dim the surrounging light and use a strong light source directed towards the cyst to see what's under the skin.  If the cyst let the light through then it is possible a ganglion cyst.

What are the causes of ganglion cyst?

At this stage, there is no one exactly know what make the cyst to develop2.  The most commonly accepted probable cause of ganglion cysts

  1. Repetitive,overuse of the wrist that causes  the synovial fluid that surrounds a joint or tendon leaks out and collects in a sac. (but the content is different from the joint fluid biochemically. Some believe that there inflammation around the injury site resulted to cyst formation)
  2. Trauma and injury:This theory suggest that injury would cause the joint tissue to break down, and form small cysts that would form a larger mass.

Risk factor of getting a ganglion cyst

Although as mentioned that the cause is yet to determine, it is agreed that the following are the risk factors that would contribute to this disease3.

  • Gender:Female are prone to this compared to male
  • Age: most of the cases the cyst occur in people between the ages of 20 to 40
  • Osteoarthritis:patient who have arthritis in the joint of the finger close to their fingernails are high risk group
  • Joint or Tendon Trauma:Joints that have been injured previously are likely to develop ganglion cyst.

Ganglion cyst treatment options

Since the cysts are often painless, there is no indication for treatment.  Usually the doctor would suggest to just observe and wait for the lump to disappear on its own.  If the cyst continue to develop or starting cause pain. If the cyst is causing disturbance with the joint mobilization or causing pain, doctor would suggest the following options:

  • Immobilization: Doctor might prescribed a brace to restrain the joint movement that would help to let the cyst shrink, once the cyst start to shrink, it would relief the pressure on the nerves that causes the pain. However, it is also not recommended to use the brace/splint in long term that would cause the surrounding muscle to waste. (seldom immobilize)
  • Aspiration: use a needle and syringe to drain the fluid out of the cyst.
  • Surgery: If the above options doesn't work, the doctor would suggest to remove the cyst and its stalk by surgery under local anaesthetic  (usually GA or MAC)
    • Arthroscopic surgery: Also known as “key-hole” surgery where a miniature size of cuts are made and a tiny camera (arthroscope) is used by the doctor as a guide to pass the instruments through the cut to remove the cyst.
    • Open surgery:Usually the doctor make a cut (approx. 5cm long, quite varied) over the the affected joint and remove the cyst.

However do note that whatever treatment options is chosen, the chance of the cyst to recurrence is still moderately high. (after surgery, recurrence rate is less)

Post Treatment

The follow up treatment depends on the treatment options that is decided.

  • For aspiration, your doctor may ask you to move your affected joint after the procedure to evaluate the result.
  • Surgery:
    • Usually the wound itself won’t be painful, however, painkillers will be given if you feel any discomfort after the operation
    • There might be some bruises around the operation site, but this should fade away quickly.
    • If stiffness , swelling or pain happens afterwards, this might be due to some minor infection which is treatable by prescribing antibiotics.
    • usually the joint will be fixed by a splint or sling and would need to last for around 7 to 10 days
  • After evaluating the progress on your condition, doctor may advise if physiotherapy or occupational therapy is needed .

Takeaway Message

Ganglion cyst is noncancerous, and often resolve by its own, once your doctor identify your lump as a ganglion cyst, they might recommend no treatment, or medical treatment.  However, it is advisable that once you noticing a strange bump or lump anywhere on your body, it is good reason to visit your doctor to identify it.

Sources:

  1. Charles D. Jennings, MD Orthoinfo [March 2013] Ganglion Cyst of the Wrist and Hand [online] Avaliable from https://orthoinfo.aaos.org/en/diseases--conditions/ganglion-cyst-of-the-wrist-and-hand/ [accessed 15 November 2021]
  2. Mayo Clinic [No date]  Ganglion Cyst[online] Available from " https://www.webmd.com/a-to-z-guides/ganglion-cyst [Accessed 15 November 2021]
  3. Cleveland Clinic [23 Novemebr 2020] Ganglion Cysts [online] Avaliable from https://my.clevelandclinic.org/health/diseases/15554-ganglion-cysts [acessed 5 Novemebr 2021]